|
MRI Elbow w/ + w/o Contrast Right
|
Professional
|
Both
|
$6,397.00
|
|
|
Service Code
|
CPT 73223 TC,RT
|
| Hospital Charge Code |
2980047
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,567.53 |
| Max. Negotiated Rate |
$6,320.24 |
| Rate for Payer: Aetna Commercial |
$6,320.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,721.48
|
| Rate for Payer: Cash Price |
$1,919.10
|
| Rate for Payer: Cash Price |
$1,919.10
|
| Rate for Payer: Cash Price |
$1,919.10
|
| Rate for Payer: Cigna Commercial |
$6,320.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,326.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,991.73
|
| Rate for Payer: Health EOS Commercial |
$6,054.12
|
| Rate for Payer: HFN Commercial |
$6,320.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,567.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,567.53
|
| Rate for Payer: Multiplan Commercial |
$5,322.30
|
| Rate for Payer: Preferred Network Access Commercial |
$6,320.24
|
| Rate for Payer: Quartz Beloit One Network |
$2,927.27
|
| Rate for Payer: Quartz Commercial |
$3,792.14
|
| Rate for Payer: The Alliance Commercial |
$3,326.44
|
| Rate for Payer: WEA Trust Commercial |
$3,659.08
|
| Rate for Payer: WPS Commercial |
$4,927.61
|
|
|
MRI Elbow w/ + w/o Contrast Right
|
Facility
|
OP
|
$6,397.00
|
|
|
Service Code
|
CPT 73223 RT,TC
|
| Hospital Charge Code |
1611041
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,862.81 |
| Max. Negotiated Rate |
$6,120.65 |
| Rate for Payer: Aetna Commercial |
$5,987.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,721.48
|
| Rate for Payer: Aetna Managed Medicare |
$1,862.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,526.03
|
| Rate for Payer: Cash Price |
$1,919.10
|
| Rate for Payer: Cash Price |
$1,919.10
|
| Rate for Payer: Cash Price |
$1,919.10
|
| Rate for Payer: Cigna Commercial |
$6,120.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,723.05
|
| Rate for Payer: Health EOS Commercial |
$5,921.06
|
| Rate for Payer: HFN Commercial |
$6,120.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,989.66
|
| Rate for Payer: Multiplan Commercial |
$5,322.30
|
| Rate for Payer: NAPHCARE Commercial |
$3,991.73
|
| Rate for Payer: Preferred Network Access Commercial |
$6,120.65
|
| Rate for Payer: Quartz Beloit One Network |
$3,259.91
|
| Rate for Payer: Quartz Commercial |
$4,324.37
|
| Rate for Payer: Quartz Medicare Advantage |
$3,991.73
|
| Rate for Payer: The Alliance Commercial |
$3,326.44
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$3,659.08
|
| Rate for Payer: WPS Commercial |
$4,927.61
|
|
|
MRI Elbow w/ + w/o Contrast Right
|
Facility
|
IP
|
$6,397.00
|
|
|
Service Code
|
CPT 73223 RT,TC
|
| Hospital Charge Code |
1611041
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,259.91 |
| Max. Negotiated Rate |
$6,120.65 |
| Rate for Payer: Aetna Commercial |
$5,987.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,721.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,526.03
|
| Rate for Payer: Cash Price |
$1,919.10
|
| Rate for Payer: Cigna Commercial |
$6,120.65
|
| Rate for Payer: Health EOS Commercial |
$5,921.06
|
| Rate for Payer: HFN Commercial |
$6,120.65
|
| Rate for Payer: Multiplan Commercial |
$5,322.30
|
| Rate for Payer: Preferred Network Access Commercial |
$6,120.65
|
| Rate for Payer: Quartz Beloit One Network |
$3,259.91
|
| Rate for Payer: Quartz Commercial |
$3,991.73
|
| Rate for Payer: WEA Trust Commercial |
$3,659.08
|
| Rate for Payer: WPS Commercial |
$4,927.61
|
|
|
MRI Elbow w/ + w/o Contrast Right
|
Professional
|
Both
|
$5,851.00
|
|
|
Service Code
|
CPT 73223
|
| Hospital Charge Code |
630831
|
| Min. Negotiated Rate |
$381.38 |
| Max. Negotiated Rate |
$5,780.79 |
| Rate for Payer: Aetna Commercial |
$5,780.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,233.13
|
| Rate for Payer: Aetna Managed Medicare |
$381.38
|
| Rate for Payer: Anthem Medicare Advantage |
$381.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$381.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$381.38
|
| Rate for Payer: Cash Price |
$1,755.30
|
| Rate for Payer: Cash Price |
$1,755.30
|
| Rate for Payer: Cash Price |
$1,755.30
|
| Rate for Payer: Cigna Commercial |
$5,780.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,042.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$381.38
|
| Rate for Payer: Health EOS Commercial |
$5,537.39
|
| Rate for Payer: HFN Commercial |
$5,780.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,567.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,567.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$381.38
|
| Rate for Payer: Multiplan Commercial |
$4,868.03
|
| Rate for Payer: NAPHCARE Commercial |
$572.07
|
| Rate for Payer: Preferred Network Access Commercial |
$5,780.79
|
| Rate for Payer: Quartz Beloit One Network |
$2,677.42
|
| Rate for Payer: Quartz Commercial |
$3,468.47
|
| Rate for Payer: Quartz Medicare Advantage |
$381.38
|
| Rate for Payer: The Alliance Commercial |
$1,449.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$381.38
|
| Rate for Payer: WEA Trust Commercial |
$3,346.77
|
| Rate for Payer: WPS Commercial |
$1,906.89
|
|
|
MRI Face Neck Orbit w/ Contrast
|
Facility
|
IP
|
$6,820.00
|
|
|
Service Code
|
CPT 70542 TC
|
| Hospital Charge Code |
1611057
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,475.47 |
| Max. Negotiated Rate |
$6,525.38 |
| Rate for Payer: Aetna Commercial |
$6,383.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,099.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,759.18
|
| Rate for Payer: Cash Price |
$2,046.00
|
| Rate for Payer: Cigna Commercial |
$6,525.38
|
| Rate for Payer: Health EOS Commercial |
$6,312.59
|
| Rate for Payer: HFN Commercial |
$6,525.38
|
| Rate for Payer: Multiplan Commercial |
$5,674.24
|
| Rate for Payer: Preferred Network Access Commercial |
$6,525.38
|
| Rate for Payer: Quartz Beloit One Network |
$3,475.47
|
| Rate for Payer: Quartz Commercial |
$4,255.68
|
| Rate for Payer: WEA Trust Commercial |
$3,901.04
|
| Rate for Payer: WPS Commercial |
$5,253.45
|
|
|
MRI Face Neck Orbit w/ Contrast
|
Professional
|
Both
|
$6,820.00
|
|
|
Service Code
|
CPT 70542 TC
|
| Hospital Charge Code |
1611057
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$190.67 |
| Max. Negotiated Rate |
$6,738.16 |
| Rate for Payer: Aetna Commercial |
$6,738.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,099.81
|
| Rate for Payer: Aetna Managed Medicare |
$190.67
|
| Rate for Payer: Anthem Medicare Advantage |
$190.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$190.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$190.67
|
| Rate for Payer: Cash Price |
$2,046.00
|
| Rate for Payer: Cash Price |
$2,046.00
|
| Rate for Payer: Cash Price |
$2,046.00
|
| Rate for Payer: Cigna Commercial |
$6,738.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,546.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$190.67
|
| Rate for Payer: Health EOS Commercial |
$6,454.45
|
| Rate for Payer: HFN Commercial |
$6,738.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$791.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$791.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$190.67
|
| Rate for Payer: Multiplan Commercial |
$5,674.24
|
| Rate for Payer: NAPHCARE Commercial |
$286.01
|
| Rate for Payer: Preferred Network Access Commercial |
$6,738.16
|
| Rate for Payer: Quartz Beloit One Network |
$3,120.83
|
| Rate for Payer: Quartz Commercial |
$4,042.90
|
| Rate for Payer: Quartz Medicare Advantage |
$190.67
|
| Rate for Payer: The Alliance Commercial |
$724.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$190.67
|
| Rate for Payer: WEA Trust Commercial |
$3,901.04
|
| Rate for Payer: WPS Commercial |
$953.37
|
|
|
MRI Face Neck Orbit w/ Contrast
|
Facility
|
IP
|
$6,951.00
|
|
|
Service Code
|
CPT 70542
|
| Hospital Charge Code |
630857
|
| Min. Negotiated Rate |
$3,542.23 |
| Max. Negotiated Rate |
$6,650.72 |
| Rate for Payer: Aetna Commercial |
$6,506.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,216.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,831.39
|
| Rate for Payer: Cash Price |
$2,085.30
|
| Rate for Payer: Cigna Commercial |
$6,650.72
|
| Rate for Payer: Health EOS Commercial |
$6,433.85
|
| Rate for Payer: HFN Commercial |
$6,650.72
|
| Rate for Payer: Multiplan Commercial |
$5,783.23
|
| Rate for Payer: Preferred Network Access Commercial |
$6,650.72
|
| Rate for Payer: Quartz Beloit One Network |
$3,542.23
|
| Rate for Payer: Quartz Commercial |
$4,337.42
|
| Rate for Payer: WEA Trust Commercial |
$3,975.97
|
| Rate for Payer: WPS Commercial |
$5,354.36
|
|
|
MRI Face Neck Orbit w/ Contrast
|
Facility
|
OP
|
$6,820.00
|
|
|
Service Code
|
CPT 70542 TC
|
| Hospital Charge Code |
1611057
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$762.69 |
| Max. Negotiated Rate |
$6,525.38 |
| Rate for Payer: Aetna Commercial |
$6,383.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,099.81
|
| Rate for Payer: Aetna Managed Medicare |
$1,985.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,759.18
|
| Rate for Payer: Cash Price |
$2,046.00
|
| Rate for Payer: Cash Price |
$2,046.00
|
| Rate for Payer: Cash Price |
$2,046.00
|
| Rate for Payer: Cash Price |
$2,046.00
|
| Rate for Payer: Cigna Commercial |
$6,525.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,969.24
|
| Rate for Payer: Health EOS Commercial |
$6,312.59
|
| Rate for Payer: HFN Commercial |
$6,525.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,319.60
|
| Rate for Payer: Multiplan Commercial |
$5,674.24
|
| Rate for Payer: NAPHCARE Commercial |
$4,255.68
|
| Rate for Payer: Preferred Network Access Commercial |
$6,525.38
|
| Rate for Payer: Quartz Beloit One Network |
$3,475.47
|
| Rate for Payer: Quartz Commercial |
$4,610.32
|
| Rate for Payer: Quartz Medicare Advantage |
$4,255.68
|
| Rate for Payer: The Alliance Commercial |
$762.69
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$3,901.04
|
| Rate for Payer: WPS Commercial |
$1,334.72
|
|
|
MRI Face Neck Orbit w/ Contrast
|
Facility
|
OP
|
$6,951.00
|
|
|
Service Code
|
CPT 70542
|
| Hospital Charge Code |
630857
|
| Min. Negotiated Rate |
$367.15 |
| Max. Negotiated Rate |
$6,650.72 |
| Rate for Payer: Aetna Commercial |
$6,506.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,216.97
|
| Rate for Payer: Aetna Managed Medicare |
$367.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,698.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,614.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,469.94
|
| Rate for Payer: Anthem Medicare Advantage |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,831.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$367.15
|
| Rate for Payer: Cash Price |
$2,085.30
|
| Rate for Payer: Cash Price |
$2,085.30
|
| Rate for Payer: Cigna Commercial |
$6,650.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$367.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,045.48
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$367.15
|
| Rate for Payer: Health EOS Commercial |
$6,433.85
|
| Rate for Payer: HFN Commercial |
$6,650.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,365.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$367.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$367.15
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$367.15
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$367.15
|
| Rate for Payer: Multiplan Commercial |
$5,783.23
|
| Rate for Payer: NAPHCARE Commercial |
$550.73
|
| Rate for Payer: Preferred Network Access Commercial |
$6,650.72
|
| Rate for Payer: Quartz Beloit One Network |
$3,542.23
|
| Rate for Payer: Quartz Commercial |
$4,698.88
|
| Rate for Payer: Quartz Medicare Advantage |
$367.15
|
| Rate for Payer: The Alliance Commercial |
$1,468.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$367.15
|
| Rate for Payer: WEA Trust Commercial |
$3,975.97
|
| Rate for Payer: Wellcare Medicare |
$367.15
|
| Rate for Payer: WPS Commercial |
$5,354.36
|
|
|
MRI Face Neck Orbit w/ Contrast
|
Professional
|
Both
|
$6,951.00
|
|
|
Service Code
|
CPT 70542
|
| Hospital Charge Code |
630857
|
| Min. Negotiated Rate |
$265.38 |
| Max. Negotiated Rate |
$6,867.59 |
| Rate for Payer: Aetna Commercial |
$6,867.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,216.97
|
| Rate for Payer: Aetna Managed Medicare |
$265.38
|
| Rate for Payer: Anthem Medicare Advantage |
$265.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$265.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$265.38
|
| Rate for Payer: Cash Price |
$2,085.30
|
| Rate for Payer: Cash Price |
$2,085.30
|
| Rate for Payer: Cash Price |
$2,085.30
|
| Rate for Payer: Cigna Commercial |
$6,867.59
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,614.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$265.38
|
| Rate for Payer: Health EOS Commercial |
$6,578.43
|
| Rate for Payer: HFN Commercial |
$6,867.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,073.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,073.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$265.38
|
| Rate for Payer: Multiplan Commercial |
$5,783.23
|
| Rate for Payer: NAPHCARE Commercial |
$398.07
|
| Rate for Payer: Preferred Network Access Commercial |
$6,867.59
|
| Rate for Payer: Quartz Beloit One Network |
$3,180.78
|
| Rate for Payer: Quartz Commercial |
$4,120.55
|
| Rate for Payer: Quartz Medicare Advantage |
$265.38
|
| Rate for Payer: The Alliance Commercial |
$1,008.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$265.38
|
| Rate for Payer: WEA Trust Commercial |
$3,975.97
|
| Rate for Payer: WPS Commercial |
$1,326.88
|
|
|
MRI Face Neck Orbit w/o Contrast
|
Facility
|
OP
|
$6,194.00
|
|
|
Service Code
|
CPT 70540 TC
|
| Hospital Charge Code |
1611059
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$646.46 |
| Max. Negotiated Rate |
$5,926.42 |
| Rate for Payer: Aetna Commercial |
$5,797.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,539.91
|
| Rate for Payer: Aetna Managed Medicare |
$1,803.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,414.13
|
| Rate for Payer: Cash Price |
$1,858.20
|
| Rate for Payer: Cash Price |
$1,858.20
|
| Rate for Payer: Cash Price |
$1,858.20
|
| Rate for Payer: Cash Price |
$1,858.20
|
| Rate for Payer: Cigna Commercial |
$5,926.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,604.91
|
| Rate for Payer: Health EOS Commercial |
$5,733.17
|
| Rate for Payer: HFN Commercial |
$5,926.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,831.32
|
| Rate for Payer: Multiplan Commercial |
$5,153.41
|
| Rate for Payer: NAPHCARE Commercial |
$3,865.06
|
| Rate for Payer: Preferred Network Access Commercial |
$5,926.42
|
| Rate for Payer: Quartz Beloit One Network |
$3,156.46
|
| Rate for Payer: Quartz Commercial |
$4,187.14
|
| Rate for Payer: Quartz Medicare Advantage |
$3,865.06
|
| Rate for Payer: The Alliance Commercial |
$646.46
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$3,542.97
|
| Rate for Payer: WPS Commercial |
$1,131.31
|
|
|
MRI Face Neck Orbit w/o Contrast
|
Facility
|
IP
|
$6,194.00
|
|
|
Service Code
|
CPT 70540 TC
|
| Hospital Charge Code |
1611059
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,156.46 |
| Max. Negotiated Rate |
$5,926.42 |
| Rate for Payer: Aetna Commercial |
$5,797.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,539.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,414.13
|
| Rate for Payer: Cash Price |
$1,858.20
|
| Rate for Payer: Cigna Commercial |
$5,926.42
|
| Rate for Payer: Health EOS Commercial |
$5,733.17
|
| Rate for Payer: HFN Commercial |
$5,926.42
|
| Rate for Payer: Multiplan Commercial |
$5,153.41
|
| Rate for Payer: Preferred Network Access Commercial |
$5,926.42
|
| Rate for Payer: Quartz Beloit One Network |
$3,156.46
|
| Rate for Payer: Quartz Commercial |
$3,865.06
|
| Rate for Payer: WEA Trust Commercial |
$3,542.97
|
| Rate for Payer: WPS Commercial |
$4,771.24
|
|
|
MRI Face Neck Orbit w/o Contrast
|
Professional
|
Both
|
$6,194.00
|
|
|
Service Code
|
CPT 70540 TC
|
| Hospital Charge Code |
1611059
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$161.62 |
| Max. Negotiated Rate |
$6,119.67 |
| Rate for Payer: Aetna Commercial |
$6,119.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,539.91
|
| Rate for Payer: Aetna Managed Medicare |
$161.62
|
| Rate for Payer: Anthem Medicare Advantage |
$161.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$161.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$161.62
|
| Rate for Payer: Cash Price |
$1,858.20
|
| Rate for Payer: Cash Price |
$1,858.20
|
| Rate for Payer: Cash Price |
$1,858.20
|
| Rate for Payer: Cigna Commercial |
$6,119.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,220.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$161.62
|
| Rate for Payer: Health EOS Commercial |
$5,862.00
|
| Rate for Payer: HFN Commercial |
$6,119.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$669.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$669.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$161.62
|
| Rate for Payer: Multiplan Commercial |
$5,153.41
|
| Rate for Payer: NAPHCARE Commercial |
$242.42
|
| Rate for Payer: Preferred Network Access Commercial |
$6,119.67
|
| Rate for Payer: Quartz Beloit One Network |
$2,834.37
|
| Rate for Payer: Quartz Commercial |
$3,671.80
|
| Rate for Payer: Quartz Medicare Advantage |
$161.62
|
| Rate for Payer: The Alliance Commercial |
$614.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$161.62
|
| Rate for Payer: WEA Trust Commercial |
$3,542.97
|
| Rate for Payer: WPS Commercial |
$808.08
|
|
|
MRI Face Neck Orbit w/o Contrast
|
Facility
|
IP
|
$6,080.00
|
|
|
Service Code
|
CPT 70540
|
| Hospital Charge Code |
630859
|
| Min. Negotiated Rate |
$3,098.37 |
| Max. Negotiated Rate |
$5,817.34 |
| Rate for Payer: Aetna Commercial |
$5,690.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,437.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,351.30
|
| Rate for Payer: Cash Price |
$1,824.00
|
| Rate for Payer: Cigna Commercial |
$5,817.34
|
| Rate for Payer: Health EOS Commercial |
$5,627.65
|
| Rate for Payer: HFN Commercial |
$5,817.34
|
| Rate for Payer: Multiplan Commercial |
$5,058.56
|
| Rate for Payer: Preferred Network Access Commercial |
$5,817.34
|
| Rate for Payer: Quartz Beloit One Network |
$3,098.37
|
| Rate for Payer: Quartz Commercial |
$3,793.92
|
| Rate for Payer: WEA Trust Commercial |
$3,477.76
|
| Rate for Payer: WPS Commercial |
$4,683.42
|
|
|
MRI Face Neck Orbit w/o Contrast
|
Facility
|
OP
|
$6,080.00
|
|
|
Service Code
|
CPT 70540
|
| Hospital Charge Code |
630859
|
| Min. Negotiated Rate |
$251.10 |
| Max. Negotiated Rate |
$5,817.34 |
| Rate for Payer: Aetna Commercial |
$5,690.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,437.95
|
| Rate for Payer: Aetna Managed Medicare |
$251.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,110.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,161.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,035.14
|
| Rate for Payer: Anthem Medicare Advantage |
$251.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,351.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$251.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$251.10
|
| Rate for Payer: Cash Price |
$1,824.00
|
| Rate for Payer: Cash Price |
$1,824.00
|
| Rate for Payer: Cigna Commercial |
$5,817.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$251.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,538.56
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$251.10
|
| Rate for Payer: Health EOS Commercial |
$5,627.65
|
| Rate for Payer: HFN Commercial |
$5,817.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$934.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$251.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$251.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$251.10
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$251.10
|
| Rate for Payer: Multiplan Commercial |
$5,058.56
|
| Rate for Payer: NAPHCARE Commercial |
$376.65
|
| Rate for Payer: Preferred Network Access Commercial |
$5,817.34
|
| Rate for Payer: Quartz Beloit One Network |
$3,098.37
|
| Rate for Payer: Quartz Commercial |
$4,110.08
|
| Rate for Payer: Quartz Medicare Advantage |
$251.10
|
| Rate for Payer: The Alliance Commercial |
$1,004.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$251.10
|
| Rate for Payer: WEA Trust Commercial |
$3,477.76
|
| Rate for Payer: Wellcare Medicare |
$251.10
|
| Rate for Payer: WPS Commercial |
$4,683.42
|
|
|
MRI Face Neck Orbit w/o Contrast
|
Professional
|
Both
|
$6,080.00
|
|
|
Service Code
|
CPT 70540
|
| Hospital Charge Code |
630859
|
| Min. Negotiated Rate |
$223.52 |
| Max. Negotiated Rate |
$6,007.04 |
| Rate for Payer: Aetna Commercial |
$6,007.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,437.95
|
| Rate for Payer: Aetna Managed Medicare |
$223.52
|
| Rate for Payer: Anthem Medicare Advantage |
$223.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$223.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$223.52
|
| Rate for Payer: Cash Price |
$1,824.00
|
| Rate for Payer: Cash Price |
$1,824.00
|
| Rate for Payer: Cash Price |
$1,824.00
|
| Rate for Payer: Cigna Commercial |
$6,007.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,161.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$223.52
|
| Rate for Payer: Health EOS Commercial |
$5,754.11
|
| Rate for Payer: HFN Commercial |
$6,007.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$902.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$902.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$223.52
|
| Rate for Payer: Multiplan Commercial |
$5,058.56
|
| Rate for Payer: NAPHCARE Commercial |
$335.28
|
| Rate for Payer: Preferred Network Access Commercial |
$6,007.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,782.21
|
| Rate for Payer: Quartz Commercial |
$3,604.22
|
| Rate for Payer: Quartz Medicare Advantage |
$223.52
|
| Rate for Payer: The Alliance Commercial |
$849.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$223.52
|
| Rate for Payer: WEA Trust Commercial |
$3,477.76
|
| Rate for Payer: WPS Commercial |
$1,117.58
|
|
|
MRI Face Neck Orbit w/ + w/o Contrast
|
Professional
|
Both
|
$6,129.00
|
|
|
Service Code
|
CPT 70543
|
| Hospital Charge Code |
630853
|
| Min. Negotiated Rate |
$335.45 |
| Max. Negotiated Rate |
$6,055.45 |
| Rate for Payer: Aetna Commercial |
$6,055.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,481.78
|
| Rate for Payer: Aetna Managed Medicare |
$335.45
|
| Rate for Payer: Anthem Medicare Advantage |
$335.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$335.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$335.45
|
| Rate for Payer: Cash Price |
$1,838.70
|
| Rate for Payer: Cash Price |
$1,838.70
|
| Rate for Payer: Cash Price |
$1,838.70
|
| Rate for Payer: Cigna Commercial |
$6,055.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,187.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$335.45
|
| Rate for Payer: Health EOS Commercial |
$5,800.49
|
| Rate for Payer: HFN Commercial |
$6,055.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,351.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,351.51
|
| Rate for Payer: Independent Care Health Plan Medicare |
$335.45
|
| Rate for Payer: Multiplan Commercial |
$5,099.33
|
| Rate for Payer: NAPHCARE Commercial |
$503.18
|
| Rate for Payer: Preferred Network Access Commercial |
$6,055.45
|
| Rate for Payer: Quartz Beloit One Network |
$2,804.63
|
| Rate for Payer: Quartz Commercial |
$3,633.27
|
| Rate for Payer: Quartz Medicare Advantage |
$335.45
|
| Rate for Payer: The Alliance Commercial |
$1,274.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$335.45
|
| Rate for Payer: WEA Trust Commercial |
$3,505.79
|
| Rate for Payer: WPS Commercial |
$1,677.26
|
|
|
MRI Face Neck Orbit w/ + w/o Contrast
|
Facility
|
OP
|
$7,100.00
|
|
|
Service Code
|
CPT 70543 TC
|
| Hospital Charge Code |
1611055
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$946.36 |
| Max. Negotiated Rate |
$6,793.28 |
| Rate for Payer: Aetna Commercial |
$6,645.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,350.24
|
| Rate for Payer: Aetna Managed Medicare |
$2,067.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,913.52
|
| Rate for Payer: Cash Price |
$2,130.00
|
| Rate for Payer: Cash Price |
$2,130.00
|
| Rate for Payer: Cash Price |
$2,130.00
|
| Rate for Payer: Cash Price |
$2,130.00
|
| Rate for Payer: Cigna Commercial |
$6,793.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,132.20
|
| Rate for Payer: Health EOS Commercial |
$6,571.76
|
| Rate for Payer: HFN Commercial |
$6,793.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,538.00
|
| Rate for Payer: Multiplan Commercial |
$5,907.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,430.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,793.28
|
| Rate for Payer: Quartz Beloit One Network |
$3,618.16
|
| Rate for Payer: Quartz Commercial |
$4,799.60
|
| Rate for Payer: Quartz Medicare Advantage |
$4,430.40
|
| Rate for Payer: The Alliance Commercial |
$946.36
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$4,061.20
|
| Rate for Payer: WPS Commercial |
$1,656.13
|
|
|
MRI Face Neck Orbit w/ + w/o Contrast
|
Facility
|
OP
|
$6,129.00
|
|
|
Service Code
|
CPT 70543
|
| Hospital Charge Code |
630853
|
| Min. Negotiated Rate |
$367.15 |
| Max. Negotiated Rate |
$5,864.23 |
| Rate for Payer: Aetna Commercial |
$5,736.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,481.78
|
| Rate for Payer: Aetna Managed Medicare |
$367.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,143.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,187.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,059.60
|
| Rate for Payer: Anthem Medicare Advantage |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,378.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$367.15
|
| Rate for Payer: Cash Price |
$1,838.70
|
| Rate for Payer: Cash Price |
$1,838.70
|
| Rate for Payer: Cigna Commercial |
$5,864.23
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$367.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,567.08
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$367.15
|
| Rate for Payer: Health EOS Commercial |
$5,673.00
|
| Rate for Payer: HFN Commercial |
$5,864.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,365.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$367.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$367.15
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$367.15
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$367.15
|
| Rate for Payer: Multiplan Commercial |
$5,099.33
|
| Rate for Payer: NAPHCARE Commercial |
$550.73
|
| Rate for Payer: Preferred Network Access Commercial |
$5,864.23
|
| Rate for Payer: Quartz Beloit One Network |
$3,123.34
|
| Rate for Payer: Quartz Commercial |
$4,143.20
|
| Rate for Payer: Quartz Medicare Advantage |
$367.15
|
| Rate for Payer: The Alliance Commercial |
$1,468.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$367.15
|
| Rate for Payer: WEA Trust Commercial |
$3,505.79
|
| Rate for Payer: Wellcare Medicare |
$367.15
|
| Rate for Payer: WPS Commercial |
$4,721.17
|
|
|
MRI Face Neck Orbit w/ + w/o Contrast
|
Facility
|
IP
|
$6,129.00
|
|
|
Service Code
|
CPT 70543
|
| Hospital Charge Code |
630853
|
| Min. Negotiated Rate |
$3,123.34 |
| Max. Negotiated Rate |
$5,864.23 |
| Rate for Payer: Aetna Commercial |
$5,736.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,481.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,378.30
|
| Rate for Payer: Cash Price |
$1,838.70
|
| Rate for Payer: Cigna Commercial |
$5,864.23
|
| Rate for Payer: Health EOS Commercial |
$5,673.00
|
| Rate for Payer: HFN Commercial |
$5,864.23
|
| Rate for Payer: Multiplan Commercial |
$5,099.33
|
| Rate for Payer: Preferred Network Access Commercial |
$5,864.23
|
| Rate for Payer: Quartz Beloit One Network |
$3,123.34
|
| Rate for Payer: Quartz Commercial |
$3,824.50
|
| Rate for Payer: WEA Trust Commercial |
$3,505.79
|
| Rate for Payer: WPS Commercial |
$4,721.17
|
|
|
MRI Face Neck Orbit w/ + w/o Contrast
|
Facility
|
IP
|
$7,100.00
|
|
|
Service Code
|
CPT 70543 TC
|
| Hospital Charge Code |
1611055
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,618.16 |
| Max. Negotiated Rate |
$6,793.28 |
| Rate for Payer: Aetna Commercial |
$6,645.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,350.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,913.52
|
| Rate for Payer: Cash Price |
$2,130.00
|
| Rate for Payer: Cigna Commercial |
$6,793.28
|
| Rate for Payer: Health EOS Commercial |
$6,571.76
|
| Rate for Payer: HFN Commercial |
$6,793.28
|
| Rate for Payer: Multiplan Commercial |
$5,907.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6,793.28
|
| Rate for Payer: Quartz Beloit One Network |
$3,618.16
|
| Rate for Payer: Quartz Commercial |
$4,430.40
|
| Rate for Payer: WEA Trust Commercial |
$4,061.20
|
| Rate for Payer: WPS Commercial |
$5,469.13
|
|
|
MRI Face Neck Orbit w/ + w/o Contrast
|
Professional
|
Both
|
$7,100.00
|
|
|
Service Code
|
CPT 70543 TC
|
| Hospital Charge Code |
1611055
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$236.59 |
| Max. Negotiated Rate |
$7,014.80 |
| Rate for Payer: Aetna Commercial |
$7,014.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,350.24
|
| Rate for Payer: Aetna Managed Medicare |
$236.59
|
| Rate for Payer: Anthem Medicare Advantage |
$236.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$236.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$236.59
|
| Rate for Payer: Cash Price |
$2,130.00
|
| Rate for Payer: Cash Price |
$2,130.00
|
| Rate for Payer: Cash Price |
$2,130.00
|
| Rate for Payer: Cigna Commercial |
$7,014.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,692.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$236.59
|
| Rate for Payer: Health EOS Commercial |
$6,719.44
|
| Rate for Payer: HFN Commercial |
$7,014.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$979.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$979.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$236.59
|
| Rate for Payer: Multiplan Commercial |
$5,907.20
|
| Rate for Payer: NAPHCARE Commercial |
$354.88
|
| Rate for Payer: Preferred Network Access Commercial |
$7,014.80
|
| Rate for Payer: Quartz Beloit One Network |
$3,248.96
|
| Rate for Payer: Quartz Commercial |
$4,208.88
|
| Rate for Payer: Quartz Medicare Advantage |
$236.59
|
| Rate for Payer: The Alliance Commercial |
$899.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$236.59
|
| Rate for Payer: WEA Trust Commercial |
$4,061.20
|
| Rate for Payer: WPS Commercial |
$1,182.95
|
|
|
MRI Femur w/ Contrast Bilat
|
Professional
|
Both
|
$4,714.00
|
|
|
Service Code
|
CPT 73719 TC,LT
|
| Hospital Charge Code |
1611067
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,049.15 |
| Max. Negotiated Rate |
$4,657.43 |
| Rate for Payer: Aetna Commercial |
$4,657.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,216.20
|
| Rate for Payer: Cash Price |
$1,414.20
|
| Rate for Payer: Cash Price |
$1,414.20
|
| Rate for Payer: Cash Price |
$1,414.20
|
| Rate for Payer: Cigna Commercial |
$4,657.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,451.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,941.54
|
| Rate for Payer: Health EOS Commercial |
$4,461.33
|
| Rate for Payer: HFN Commercial |
$4,657.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,049.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,049.15
|
| Rate for Payer: Multiplan Commercial |
$3,922.05
|
| Rate for Payer: Preferred Network Access Commercial |
$4,657.43
|
| Rate for Payer: Quartz Beloit One Network |
$2,157.13
|
| Rate for Payer: Quartz Commercial |
$2,794.46
|
| Rate for Payer: The Alliance Commercial |
$2,451.28
|
| Rate for Payer: WEA Trust Commercial |
$2,696.41
|
| Rate for Payer: WPS Commercial |
$3,631.19
|
|
|
MRI Femur w/ Contrast Bilat
|
Facility
|
OP
|
$9,612.00
|
|
|
Service Code
|
CPT 73719
|
| Hospital Charge Code |
630867
|
| Min. Negotiated Rate |
$367.15 |
| Max. Negotiated Rate |
$9,196.76 |
| Rate for Payer: Aetna Commercial |
$8,996.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,596.97
|
| Rate for Payer: Aetna Managed Medicare |
$367.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,497.71
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,998.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,798.31
|
| Rate for Payer: Anthem Medicare Advantage |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,298.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$367.15
|
| Rate for Payer: Cash Price |
$2,883.60
|
| Rate for Payer: Cash Price |
$2,883.60
|
| Rate for Payer: Cigna Commercial |
$9,196.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$367.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,594.18
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$367.15
|
| Rate for Payer: Health EOS Commercial |
$8,896.87
|
| Rate for Payer: HFN Commercial |
$9,196.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,365.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$367.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$367.15
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$367.15
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$367.15
|
| Rate for Payer: Multiplan Commercial |
$7,997.18
|
| Rate for Payer: NAPHCARE Commercial |
$550.73
|
| Rate for Payer: Preferred Network Access Commercial |
$9,196.76
|
| Rate for Payer: Quartz Beloit One Network |
$4,898.28
|
| Rate for Payer: Quartz Commercial |
$6,497.71
|
| Rate for Payer: Quartz Medicare Advantage |
$367.15
|
| Rate for Payer: The Alliance Commercial |
$1,468.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$367.15
|
| Rate for Payer: WEA Trust Commercial |
$5,498.06
|
| Rate for Payer: Wellcare Medicare |
$367.15
|
| Rate for Payer: WPS Commercial |
$7,404.12
|
|
|
MRI Femur w/ Contrast Bilat
|
Professional
|
Both
|
$9,612.00
|
|
|
Service Code
|
CPT 73719
|
| Hospital Charge Code |
630867
|
| Min. Negotiated Rate |
$260.05 |
| Max. Negotiated Rate |
$9,496.66 |
| Rate for Payer: Aetna Commercial |
$9,496.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,596.97
|
| Rate for Payer: Aetna Managed Medicare |
$260.05
|
| Rate for Payer: Anthem Medicare Advantage |
$260.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$260.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$260.05
|
| Rate for Payer: Cash Price |
$2,883.60
|
| Rate for Payer: Cash Price |
$2,883.60
|
| Rate for Payer: Cash Price |
$2,883.60
|
| Rate for Payer: Cigna Commercial |
$9,496.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4,998.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$260.05
|
| Rate for Payer: Health EOS Commercial |
$9,096.80
|
| Rate for Payer: HFN Commercial |
$9,496.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,049.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,049.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$260.05
|
| Rate for Payer: Multiplan Commercial |
$7,997.18
|
| Rate for Payer: NAPHCARE Commercial |
$390.08
|
| Rate for Payer: Preferred Network Access Commercial |
$9,496.66
|
| Rate for Payer: Quartz Beloit One Network |
$4,398.45
|
| Rate for Payer: Quartz Commercial |
$5,697.99
|
| Rate for Payer: Quartz Medicare Advantage |
$260.05
|
| Rate for Payer: The Alliance Commercial |
$988.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$260.05
|
| Rate for Payer: WEA Trust Commercial |
$5,498.06
|
| Rate for Payer: WPS Commercial |
$1,300.26
|
|
